[The assessment of surgical treatment of patients with malignant pleural effusion].

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

[Adjuvant lymphotrophic chemotherapy in the surgical treatment of progressive pulmonary tuberculosis].

The study was undertaken to enhance the efficiency of surgical treatment for progressive drug-resistant pulmonary tuberculosis, by applying adjuvant lymphotropic chemotherapy (ALCT). Seventy-one patients were examined and operated on; of them 35 patients received ALCT and 36 patients formed a control group. The determinants of the efficiency of the performed treatment were the frequency of specific postoperative complications. ALCT used in combination with the conventional antituberculous treatments made it possible to enhance the efficiency of surgical treatment, by halving the number of postoperative complications, reducing the duration of a postoperative period, and enhancing the intensity of chemotherapy, by taking into account the data on the resistance of a pathogen, without causing adverse reactions, and to improve the psychoemotional status of patients.

[Differential approach to lymphadenectomy in patients with progressive fibrocavernous pulmonary tuberculosis].

The resection specimens from 31 patients with fibrocavernous tuberculosis (FCT) underwent a complex clinical andimmunological study, as well as a morphological one. It was ascertained that partial or extended lymphadenectomy did not always positively correlate with an adequate postoperative immune response and it depended on the morphological features of lymphatic apparatus lesion. The direct results of surgical treatment of patients with FCT suggest that in patients with specific lymphadenitis and cell-mediated immunodeficiency, the frequency of postoperative specific pleuropulmonary complications and their severity considerably exceed those if there is an adequate immune response. In patients with progressive FCT, baseline cell-mediated immunity deficiency is aggravated by surgery, increasing the risk of postoperative specific and nonspecific infectious pleuropulmonary complications.

[The experience of applying of exogenous monoxide of nitrogen and argon plasma coagulation by cavernotomy in patients with fibro-cavernous pulmonary tuberculosis with the presence of multiple drug resistance].

The presented paper discusses the experience with exogenous nitric oxide (NO) and argon plasma coagulation (APC) used at cavernotomy in 31 patients with multidrug-resistant fibrocavernous pulmonary tuberculosis. Supplementary treatments depending in infectious risk factors were comprehensively evaluated. The application of APC and NO significantly improved the results of open cavern sanitation, as evidenced by the bacterial excretion index, and doubled the immediate efficiency of surgical treatment.

[Pathological characteristics of drug-resistant fibrocavernous pulmonary tuberculosis].

A histological examination of the pulmonary and bronchopulmonary lymph nodes was made in 47 patients treated surgically for fibrocavernous pulmonary tuberculosis. The speed of immunopathological reactions development is the main reason of differences between drug-resistant and drug-sensitive primary tuberculosis. Formation of cellular immunity in drug-resistant tuberculosis has all necessary morphological prerequisites both in the lungs and lymph nodes but their realization is delayed. Immunogenesis concentrates on the early stages when initial paraspecific reactions prevail. Morphologically, they are most demonstrative in the bronchial walls where in different patients or even in one patient but in various bronchi all reactions of delayed type (contact, tuberculine type and granulematous) can be simultaneously observed.

[The diagnosis and treatment of acute pulmonary circulatory disorders after resection for tuberculosis].

The authors analyzed postoperative complications after 4174 pulmonectomies for tuberculosis in the period of 1982-2004. The verified cases of acute venous circulatory disorders in the remnants of the lung after partial resections were observed in 12 (0.3%) patients. The main causes of hemorrhagic infarct of the part of the lung were erroneous ligation of the vein or its rupture; thrombosis of the venous trunk; partial removal of a pulmonary portion with devascularized tissue left; extensive intrapulmonary hematomas. In case of acute circulatory disorder developed in the resected lung, mortality may amount to as high as 58% due to secondary complications (sepsis in the presence of generalized gangrene and lung tissue decay, purulent pleurisy with bronchopleurothoracic fistulas, arrosion profuse hemorrhage). The above complication is a rare, but extremely severe iatrogenic abnormality largely associated with shortcomings of surgical techniques.

[Peptic ulcer is a risk factor in the surgical treatment of pulmonary tuberculosis]. / Iazvennaia bolezn' -- faktor riska pri khirurgicheskom lechenii tuberkuleza legkikh.

Peptic ulcer of the stomach and duodenum is the most common (10-18%) concomitant gastrointestinal pathology in phthisiosurgical patients. Treatment of these patients presents a challenge due to a drastic reduction in the efficiency of oral antibacterial therapy resulted from poor tolerability of chemical drugs and to a risk for surgical complications particularly in the early period after lung surgery. In 1996-2002, a total of 495 patients with tuberculosis at various sites were endoscopically studied; peptic ulcer in different phases was detected in 30.9% of the patients. There has been a considerable increase in the incidence of peptic ulcer among phthisiosurgical patients in the past 3 years (up to 16-17% among those undergone lung surgery for tuberculosis). A package of measures has been developed to reduce the incidence of life-threatening complications due to peptic ulcer in the postoperative period. It is concluded that peptic ulcer is a significant risk factor in phthisiosurgery as a serious contraindication to planned surgery and as a source of postoperative complications.